Vaccine Hesitancy Counseling

I recently gave a morning report lecture on a case of influenza that I saw in the emergency room that resulted in really serious complications for the child. As part of the talk, I spent some time discussing the strategies I use to get my patients and parents to accept a flu shot, since not everyone is all that excited about an “extra” vaccine. I have posted a couple times on instagram about how important I think the flu shot is and have gotten a lot of great responses and some requests for more tips on counseling on vaccine hesitancy especially as it pertains to the flu shot, so I thought I’d share some content from my slides on here. I hope you guys find it useful!

Q: Does the flu shot actually work?

  • A: Yes. In an average year there is a 40-60% risk reduction on infection. Some years it is higher and some years it is lower, but even a 10% risk reduction is better than a 0% risk reduction.
  • A: check out the CDC’s list of studies published on how effective the flu vaccine is!

Q: Does the flu shot benefit society?

  • A: For healthy adults, there is not a huge economic advantage in getting the vaccine. However, for older adults, children, and people with significant chronic disease, there is definite economic advantage in immunizing. If you’re interested, there was a study published in 2008 in the Journal of Pediatrics about how vaccinating preschool-age children paid off in terms of number of days of work missed by parents and child hospitalization rate, among other important points (Eisenberg et al).
  • A: The Journal of Infectious Diseases published an article citing benefits of 75% reduction in cases of life-threatening influenza infection in children in 2010 to 2012 (Ferdinands et al. 2014)
  • A: herd immunity is more difficult to achieve with a shot that must be delivered annually in comparison to other routine immunizations like measles or hepatitis shots, but there is definite benefit when a higher number of people are immunized.

Q: What resources are out there to help pediatricians (and other interested parties) learn to counsel patients and families more effectively?

  • A: There is an incredible e-course that is free to AAP members on all types of vaccination counseling. Most points can be applied to the flu shot. If you’re more interested in the executive summary, check out this article from Pediatrics: Clinical Update on Vaccine Hesitancy (Edwards et al., 2016).

The AAP also published a list of common questions parents are likely to ask about the flu shot (starts on page 14, although the table of contents says 17). It’s nice to be able to anticipate their concerns and to validate what they’re saying, but also important to educate and reduce belief in some myths. Here are some of my favorites:

Q: “My kids have never had the flu!”

  • A: I’m glad to hear that and I hope they don’t get it this year, but avoiding the flu in the past is not a predictor of who will get the flu in the future. Getting vaccinated is the single most important thing you can do to prevent the flu. The flu kills up to 49,000 people each year and makes many more sick. Many of these deaths occur in healthy individuals. Even one unnecessary death is too many.

Q: “I got the flu shot and it gave me the flu” or “the year I got the flu shot was the sickest I’ve ever been.”

  • A: The strains of the flu that are put into the flu shot are killed viruses. The flu shot does not and cannot cause the flu.
  • A: If someone gets a flu shot in the middle of flu season, they may already have been exposed to the flu and be coming down with it or another virus (colds are very common during flu season and can vary in severity). Because the shot and getting sick happened ate the same time, they think the flu shot gave them the flu.
  • A: It also takes about 2 weeks for the body to build protection after the shot, so some people getting sick just before or during that time period blame the shot.
  • A: The most common side effects of a flu vaccine are soreness at the site of injection and sometimes a low-grade fever. Sometimes people who experience side effects think “they got the flu.”

Q: “It doesn’t work; my kid got the flu shot and still got the flu.”

  • A: While the flu vaccine is not 100% effective, we do know that those who are vaccinated and who later get a flu virus are less likely to get really sick, be hospitalized, or have serious complications.
  • A: There are hundreds of strains of the flu and there are only 3 or 4 strains of flu in the flu vaccine. Each year scientists determine the 3 or 4 most common strains of flu virus circulating and that’s what’s included in the upcoming year’s flu vaccine. There is always the possibility that the child could get a different strain of the flu than one that’s included in the vaccine; however, if that happens, the duration and severity of symptoms is generally much less.

Q: “The flu is not really that bad, no worse than a bad cold.”

  • A: Although it is sometimes challenging to tell the difference between a cold and the flu, the flu can have serious complications and even lead to death, especially for the very young, very sick, and very old. It tends to last for several days, keeping you out of work and your child out of school. Getting vaccinated not only protects you, but those closest to you as well.

Here are some other counseling techniques I have found to be particularly effective:

  • I remind families that I got a flu shot and did not get the flu. Although it’s purely anecdotal, parents often give anecdotal reasons of their own for not vaccinating, so I fight fire with fire.
  • Remind parents of kids 3 and under that their child is getting a smaller dose of the vaccine (but keep in mind that all first-time vaccinators 8 and under need two doses at least 28 days apart).
  • Share your personal concerns about close contacts. Is there a grandmother living in the home? Dad has cancer and is immunocompromised from chemo? There is a 4-month-old ex-preemie who is too young to get the shot? These people are at high risk from infection and you should do everything in your power to protect them, including immunization of your child.
  • Remind parents who try to say “he’s already getting other shots today, let’s do it later” that that means two days of feeling pain, plus anticipation of another shot. You’re already having a bad day today with other routine immunizations, why prolong your child’s suffering?
  • It takes somewhere between 30 and 100 flu immunizations to prevent one case of the flu. That sounds like a lot, but think of it like insurance – you wouldn’t not have house insurance just because it takes 30 to 100 people paying in for you to get a payout if your house were to catch on fire.
  • Remind parents that the Vaccine Adverse Event Reporting System exists, and while not perfect, it doesn’t suggest that the flu shot is any more dangerous than any other shot.

I think the most important point about all of this is that you should never let the flu shot be a question in your mind, or else it will be a question in the patient’s mind. When I changed my catchphrase from “so… do you think you might want to get a flu shot this year?” to “your child is due for routine immunizations today, including the flu shot” my “yes” rate increased astronomically.

Let me know what questions you have, or if you have other strategies you use that are effective! (And I’m sorry in advance if I delete your comment if it’s not polite or contains profanity. For whatever reason, anti-vaxxers sometimes tend to use rude phrases when responding to me on instagram on this topic. I definitely don’t mind hearing opposite points of view, I just expect it to be professional and kind on this blog!)


4 thoughts on “Vaccine Hesitancy Counseling

  1. Thanks for this! I’m a pediatric nurse, so I’ll often have parents say, “oh, we’re doing so many other shots today that I’ll bring him/her back in a couple weeks for the flu shot” … it’s a good idea to suggest they just get it all over with at one visit. (Although we’re kind of having the opposite problem at our hospital now … so many people who wouldn’t otherwise get it are wanting to get the shot rightthissecond because of all the scary flu stories that we can’t accommodate everyone!)


  2. This is a very helpful post! I’m on my Peds rotation right now (3rd year), but it’s inpatient, so I don’t get to hear a ton of these conversations. I’d love to see a similar post for approaching patients/parents who do not want any vaccines/Vitamin K, etc. We had a newborn with a family who refused everything yesterday, and it was a very tense situation.


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